Perlèche (overview) K13.0

Polyätiological, acute or chronic, mostly rhagadiform inflammation of the corners of the mouth. Often with mycotic or bacterial infection at the base of an anatomical malposition.

First described redness and scaling in the corner of the mouth, then rhagade formation. Formation of an oval, lenticular to pea-sized, erosive-crusty plaque. Particularly in older people the finding can be completely covered by the overhanging lips and only becomes visible when the lip sections are pulled apart.

• Clinical picture with painful rhagades
• Eminently chronic course
• Therapy resistance (if cause is not eliminated)
• Often age-related lip atrophy
• Smear with examination for fungi and bacteria (not infrequently detection of yeasts (Candida species))
• Syphilisserology(Plaques muqueuses = rare cause)
• Exclusion of a diabetic metabolic condition
• Exclusion of anaemia/iron deficiency
• exclusion of avitaminosis (vitamin B12 deficiency), zinc deficiency
• Clarification of an atopic diathesis

Treatment of the underlying disease e.g.:

• Lip involution: In case of senile lip involution with overlapping wrinkles in the area of the corners of the mouth and age-related turgor loss of the facial skin, consistent lip care with regular cleaning of the corners of the mouth (e.g. with dexpanthenol ointment).
• Candidosis of the oral mucosa: consistent antimycotic therapy. S.u. Antimycotics.
• Bacterial colonisation: Apply antibiotic-containing ointments, e.g. Fucidine ointment, several times a day to the corners of the mouth. Alternatively: application of disinfectant ointments or emulsions such as 0.5% Clioquinol-Externa(e.g. Linola-Sept, R049 ). In the case of a highly inflammatory overlay, the use of combination preparations ( glucocorticoid and antibiotic or antifungal) can be helpful in the short term (e.g. Decoderm tri cream, Candio-Hermal Plus paste, Lotricomb cream). Limit glucocorticoid combination preparations to 10 days' use.
• For atopic cheilitis, use consistent lip care.

Causes of perlèche